popsicletoes: questions about tapering Celexa

[popsicletoes]

Hello,

 

I am a mom who is helping her 16 year old son (under the guidance of his psychiatrist) to taper off psychotropic medications.  He has a complex medical history with cancer and narcolepsy and mood issues.  I am not sure what, if anything, his current meds are doing for him given how long he has been on them and how much he has changed in that time.  He is currently doing very well and is in full agreement on trying to reduce/stop the medications. 

 

After 2 previous disastrous attempts to taper him off Risperal in the past (done in the traditional, much too fast way), I was able to help him taper off Risperdal this past year.  He started at a dose of 1 mg (taken as .5 mg morning and evening) in June of 2017.    As outlined on this site, I reduced him monthly by 10% of the current dose for around the first 7 months and then was then able to speed up the time between reductions (because my son was doing very well and asked me to speed it up!).

 

He has now been off Risperdal for 5 months, doing well, and I would like to try and taper him off Celexa.  His psychiatrist is in agreement with tapering him off.  Although the psychiatrist (a brand new once as my son's old psychiatrist left his practice this summer) had never heard of the 10% reduction method, he is supportive and wrote a prescription for liquid Celexa so that I can give him a combination of pill and liquid during the taper.

 

I have the liquid and I can start at any time, but I am feeling very nervous!  I thought it might help to discuss my plan here.  I also have a few questions.

 

My plan is to, as I did with the Risperdal and is recommended here, reduce the dose by 10% of the previous dose.  I have the 10 mg/5 ml Celexa solution and 10 mg tablets. My son's current dose is 30 mg, so he takes three 10 mg tables each morning.

 

Here is my reduction schedule for the first few months, starting with his current dose of Celexa, and the combination of tablet and liquid I will give him

 

30 mg:  10 mg tablet + 10 mg tablet + 5 ml liquid   (this is his current dose - just to be extra cautious I will give him a few days at this dose because of the change to a combination of liquid and pill)

27 mg: 10 mg tablet + 10 mg tablet + 3.5 ml liquid (I will have him stay at this dose for 1 month provided everything is going well) 

24.3 mg: 10 mg tablet + 10 mg tablet + 2.15 ml liquid (again, 1 month at this dose) 

 

My first question has to do with how precise to be with rounding off dosage amounts.  I have a 5 ml and a 1 ml syringe.  The 1 ml syringe is divided into hundredths, so I can get precise, but do I need to?  I did with the Risperdal taper, but I started at 1 mg, so I needed to. For example, the third reduction, rounded to the nearest hundredth of a mg, is a dose of 21.87 mg.  So, for this reduction I could give him two 10 mg tablets and .94 ml of the liquid.  Or, I could round up to 22 mg and give him the two tablets and 1 ml of liquid.    Any thoughts on precision of rounding would be appreciated!

 

My second question is what would be a good drink to mix the liquid Celexa into.  I put the Risperdal into a very small amount of milk.  I am thinking of using milk again. 

 

Thank you!

 

    

[manymoretodays]

Hi popsicletoes and welcome,

 

That's great that your son is doing so well after coming off the risperdal. 

I think congratulations are in order!  And good job with the tapering.  Sometimes we do see W/D symptoms crop up months after a taper......even so, I applaud your efforts of researching, reading, and well........just plain being here with your questions and for your son.  Looks like it's been just a little over 5 months now since you completed that taper.

And thank you for getting his signature done.

Could you do a drug interactions check and then copy and paste the results here.  https://www.drugs.com/drug_interactions.php

 

We recommend a cross over from tablets to liquid that just varies slightly from what you had in mind.  And yours does appear to be even a bit more cautious so that's great!

(no change in dose while doing and the cross over that we recommend is in black)

1/4 dose liquid and 3/4 dose tablet for 3 days  your plan is currently 1/3 dose and 2/3 dose respectively, you might consider more than a few days to see how this goes.  And then I'm wondering if you might consider continuing the cross over to liquid  to the next step of 1/2 and 1/2 BEFORE beginning the taper.

1/2 dose liquid and 1/2 dose tablet for days 4-6

......and you may want to wait longer after this change as well.........in hopes that we can avoid any symptoms during the crossover.  And then beginning the taper from here.

3/4 dose liquid and 1/4 dose tablet for days for days 7-9

and then full dose in liquid.......of course you can alter this further if needed to do the cross over even more cautiously or if new symptoms seem to arise at any point.

 

What is really important is consistency and accuracy of measurements of his dosage.  And it's obvious you are keeping this in mind which is great.  Yes, precision is important with your liquid measurements.  Here's more on using an oral syringe and other tapering techniques

I think it's best when doing tapers to round up in dosage.......so......using your example of having to give 1.87 mg using a solution of 10mg(milligram) in 5 mL(millileter) or 2 mg in 1mL.  I calculate the dose of 1.87 mg would be in 0.93 mL.  So if you need to you would round up and then administer 0.94 mL of the solution.

I hope that answers that question on precision and accuracy.  It's so hard to explain via text and words.

 

Is your son able to participate here as well?

I know it's kind of a fine line with him being 16 now, and with some other difficulties, yet that might be helpful.  What do you think?

 

I'm going to include some links that you may have already studied, just to know that you have them.

Why taper by 10% of my dosage

https://www.survivingantidepressants.org/topic/2390-dr-joseph-glenmullens-withdrawal-symptom-checklist/

What is withdrawal syndrome

One theory of antidepressant withdrawal syndrome

Brain remodeling

 

When we take medications, the CNS (central nervous system) responds by making changes over the months and years we take the drug. When the medication is discontinued, the CNS has to undo all the changes it made. Rebuilding the neurotransmitter production and reactivating the receptor and transporter cells takes time -- during that rebuilding process symptoms occur.

 

Tips for tapering Celexa/citalopram

 

I'm not certain at the moment, what to tell you to mix the Celexa in.  I'm finding some interesting information while searching for an answer to you question though.  Do you know the maker of the liquid Celexa that you have?  I'll share with you this link for Citalopram oral drops, the concentration is a bit different from what you quoted, as to what your liquid is.  https://www.medicines.org.uk/emc/product/414/smpc

You may be able to find similar product information, as to your Citalopram, or an answer to your ? of what is best to mix your solution in?

 

I've got to sign off here, and may have overloaded you with links already. 

 

Welcome aboard again pt and son.

 

Love, peace, healing, and growth,

mmt

 

Edited September 27, 2018 by manymoretodays
removed white space, additional

[popsicletoes]

1 hour ago, manymoretodays said:

Hi popsicletoes and welcome,

 

That's great that your son is doing so well after coming off the risperdal. 

I think congratulations are in order!  And good job with the tapering.  Sometimes we do see W/D symptoms crop up months after a taper......even so, I applaud your efforts of researching, reading, and well........just plain being here with your questions and for your son.  Looks like it's been just a little over 5 months now since you completed that taper.

 

Hello manymoredays,

 

Thank you for the very informative and helpful response.  To be honest, I have a lot of guilt that I did not fight harder against my son going on the medications to start with.  It was not until after he was 11 and put on Topamax by a neurologist for headaches that I came to appreciate the true nastiness of medications (well, my son had cancer, so I know how nasty and toxic chemo and radiation can be, but those were life-saving) and, in particular, of withdrawal (and he started the Topamax at the end of an unsuccessful, traditional - much too fast - attempt to taper him off of Risperdal, developed every side effect of Topamax that is known, and then had a truly miserable withdrawal from the drug).  It was this site, along with a few others, that helped me understand the magnitude that withdrawal symptoms can have.  And it was this site that helped me to put together a plan to do a 10% reduction, so thank you to all of you for sharing your stories and time.

 

I know, as you mention, that withdrawal symptoms can crop up months after the taper is complete.  Am I going to fast by starting another taper 5 months after completing the last taper?  My son just started 10th grade.  I know that if/when he goes away to college in 3 years that would not be a good time (in so many ways!) for him to be in the midst of a taper.  So, I don't want to rush the taper, but I am cognizant that I have a window to work in.  But, as I said, I am very aware of the dire consequences of a too-fast taper, so I want to be cautious.  I am feeling very nervous about starting the taper of Celexa!

 

1 hour ago, manymoretodays said:

Could you do a drug interactions check and then copy and paste the results here.  https://www.drugs.com/drug_interactions.php

 

This scares the heck out of me:

 

Print Share

 

 

Major

busPIRone citalopram

Applies to: BuSpar (buspirone), Celexa (citalopram)

Using busPIRone together with citalopram can increase the risk of a rare but serious condition called the serotonin syndrome, which may include symptoms such as confusion, hallucination, seizure, extreme changes in blood pressure, increased heart rate, fever, excessive sweating, shivering or shaking, blurred vision, muscle spasm or stiffness, tremor, incoordination, stomach cramp, nausea, vomiting, and diarrhea. Severe cases may result in coma and even death. You should seek immediate medical attention if you experience these symptoms while taking the medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

 

1 hour ago, manymoretodays said:

We recommend a cross over from tablets to liquid that just varies slightly from what you had in mind.  And yours does appear to be even a bit more cautious so that's great!

(no change in dose while doing and the cross over that we recommend is in black)

1/4 dose liquid and 3/4 dose tablet for 3 days  your plan is currently 1/3 dose and 2/3 dose respectively, you might consider more than a few days to see how this goes.  And then I'm wondering if you might consider continuing the cross over to liquid  to the next step of 1/2 and 1/2 BEFORE beginning the taper.

1/2 dose liquid and 1/2 dose tablet for days 4-6

......and you may want to wait longer after this change as well.........in hopes that we can avoid any symptoms during the crossover.  And then beginning the taper from here.

3/4 dose liquid and 1/4 dose tablet for days for days 7-9

and then full dose in liquid.......of course you can alter this further if needed to do the cross over even more cautiously or if new symptoms seem to arise at any point.

 

I am not sure I am understanding you here -- sorry!  I thought I had seen somewhere else on this site that it was ok to administer a combination of  liquid and pill form of a medication during the taper.  So, my plan was to give my son two 10 mg tablets and the remainder in liquid form for doses in the 20 - 30 mg range, one 10 mg tablet and the remainder in liquid form for the doses in the 10 - 20 mg range, and then, once the dose is below 10 mg, to give all liquid.  It there a reason to avoid the combination of pill and liquid?    

 

Thank you!

 

 

[manymoretodays]

1 hour ago, popsicletoes said:

I am not sure I am understanding you here -- sorry!  I thought I had seen somewhere else on this site that it was ok to administer a combination of  liquid and pill form of a medication during the taper.  So, my plan was to give my son two 10 mg tablets and the remainder in liquid form for doses in the 20 - 30 mg range, one 10 mg tablet and the remainder in liquid form for the doses in the 10 - 20 mg range, and then, once the dose is below 10 mg, to give all liquid.  It there a reason to avoid the combination of pill and liquid?    

 

Hi pt,

No reason to avoid the combination of pill and liquid.  My thinking was that when you do the cross over to using some liquid, rather than doing 1/3 of liquid and 2/3 of tablet to get the total daily dose...........you might do 1/2 liquid(partial dose) and 1/2 tablet(partial dose) to equal the total daily dose.  So with the present dose of 30mg Celexa........you'd slowly work on crossing over his present total dosage of 30 mg to be giving 15 mg using the liquid and then 15 mg using the tablets.

 

Best to start the crossover with 1/4 daily dose in liquid and 3/4 daily dose in tablet, which is less than 1/3 and 2/3.  And then once he's adjusted to that change in absorption.......you might give it at least 3 days.  Then go with 1/2 liquid and 1/2 tablet for the duration until you get to lower doses.

When you get down to 10 mg and he is only taking one tablet........you'll then again need to cross over cautiously to all liquid.

 

The absorption of the liquid Celexa is a bit different from the absorption of the tablet form, so we want to give him time to adjust to the difference.  We treat this kind of change like a dose change.

 

 Is that part clearer?

I know, it IS scary how many drugs get prescribed together with potentials for interactions.  His 2 present medications may be competing for the same liver enzyme, in a way......that's my simple explanation and I'm not sure on this......yet.   Hopefully that's why your prescriber is in agreement with your tapering plan......due to interactions........I hope so.   I'm glad your son is doing okay NOW.  And his Mom is becoming empowered with information, right?

 

Just be cautious from here on out.  Drugs.com is a good site to check medications on quickly.

 

Why was he ever put on risperdal??  Did they start the risperdal and Celexa/citalopram at the same time back in 2010?

 

Oh and here's the information from drugs.com on the form of liquid Citalopram that you have.  Citalopram Oral Solution

Don't hesitate to talk with your pharmacist too......or ask questions of him/her.  I've found them to be helpful in the past.

 

Best,

mmt

 

 

 

 

 

Edited September 27, 2018 by manymoretodays

[manymoretodays]

6 hours ago, popsicletoes said:

I know, as you mention, that withdrawal symptoms can crop up months after the taper is complete.  Am I going to fast by starting another taper 5 months after completing the last taper?  My son just started 10th grade.  I know that if/when he goes away to college in 3 years that would not be a good time (in so many ways!) for him to be in the midst of a taper.  So, I don't want to rush the taper, but I am cognizant that I have a window to work in.  But, as I said, I am very aware of the dire consequences of a too-fast taper, so I want to be cautious.  I am feeling very nervous about starting the taper of Celexa!

 

Ideally, we would hope that with a really cautious and slow taper of 10% or less there would be no withdrawal symptoms............yet, often that may not be the case.

So.......you may do best waiting until your 6 months out from the last taper, and then if he is in agreement and doing well..........perhaps tapering at even less than 10%.  And not focusing so much on being completely medication free by such and such a time........but focusing on getting him to a lower dosage of the Celexa/citalopram.  And then once there, recalculate and plan again.  Many people take several years to do a taper.  Some do a microtaper or a brassmonkeyslide method taper. 

 

It's a tough call.  And wonderful if you can get his involvement, and participation in the whole effort. 

 

Two supplements that may be helpful in withdrawal and are great to have in your toolbox are:

King of supplements: Omega 3's
Magnesium, nature's calcium channel blocker

Best to start with one at a time, low dose first

 

Best to you both,

mmt

Edited September 28, 2018 by manymoretodays

[Altostrata]

On 9/27/2018 at 1:22 PM, manymoretodays said:

We recommend a cross over from tablets to liquid that just varies slightly from what you had in mind.  And yours does appear to be even a bit more cautious so that's great!

(no change in dose while doing and the cross over that we recommend is in black)

1/4 dose liquid and 3/4 dose tablet for 3 days  your plan is currently 1/3 dose and 2/3 dose respectively, you might consider more than a few days to see how this goes.  And then I'm wondering if you might consider continuing the cross over to liquid  to the next step of 1/2 and 1/2 BEFORE beginning the taper.

1/2 dose liquid and 1/2 dose tablet for days 4-6

......and you may want to wait longer after this change as well.........in hopes that we can avoid any symptoms during the crossover.  And then beginning the taper from here.

3/4 dose liquid and 1/4 dose tablet for days for days 7-9

and then full dose in liquid.......of course you can alter this further if needed to do the cross over even more cautiously or if new symptoms seem to arise at any point.

 

Hi, popsicletoes (great name!). I would like to suggest a method you might find somewhat easier: Convert to liquid only when you have to. Stick with 2 tablets of Celexa plus enough liquid to top up for several months, exactly as you proposed here:

 

On 9/25/2018 at 7:46 AM, popsicletoes said:

30 mg:  10 mg tablet + 10 mg tablet + 5 ml liquid   (this is his current dose - just to be extra cautious I will give him a few days at this dose because of the change to a combination of liquid and pill)

27 mg: 10 mg tablet + 10 mg tablet + 3.5 ml liquid (I will have him stay at this dose for 1 month provided everything is going well) 

24.3 mg: 10 mg tablet + 10 mg tablet + 2.15 ml liquid (again, 1 month at this dose) 

 

Stay with the 2 tablets plus liquid method for a few more steps until the next dose is about 19.7mg. Then you would switch to one 10mg tablet plus 9.7mg in liquid form.

 

(Personally, I would take two 10mg tablets or 20mg for this step, it's close enough to 19.7mg, you can take a month's break from measuring. In the next step, switch to one 10mg tablet plus 8mg in liquid.)

 

You had a question about rounding in the liquid measurement: I would round up to make the decrease smaller rather than larger. Be sure to make a note of your new measurement, because for the next step, you will want to calculate 10% on the actual last dosage.

 

As long as you stay within a 10% decrement, the taper will be slow enough.

 

Good to hear your son was able to go faster in the last leg to go off Risperdal. This may or may not be true with Celexa. It sounds like you two are communicating well and you will be on the alert for withdrawal symptoms. You seem to have a very good understanding of tapering techniques.

 

Please let us know how you and your son are doing.

[popsicletoes]

Hi again MMT and hello Altostrata,

 

Thank you both for taking the time to offer your guidance!  I think I am more nervous to start the citalopram taper than I was for the Risperdal taper because I have read so much about how difficult coming off of an SSRI can be.  It is also hard because I am not in my son's head (thank goodness😉!), so I have to count on him to let me know if something doesn't feel right.  But he is 16, so he is in the midst of many changes.

 

My son is very much wanting to do the medication taper, which is a good thing because he absolutely hates the taste of the liquid citalopram.  I am glad that I can give him a combination of pills and liquid, which cuts down on the amount of liquid.  I started him on the combination pills and liquid a few days ago at his current dose of 30 mg.  I have been putting the liquid citalopram in a very small amount of milk (per my son's request) to help him get it down.  He tries to toss the milk/citalopram to the back of his throat so he does not taste it and then he quickly drinks a glass of lemonade.  I will wait a few more days until I make the first reduction.

 

I forgot to mention above that I have had my son on Omega 3 and a multivitamin with magnesium since before he started the Risperdal taper last year.  

 

To answer some of the questions above...

 

On ‎9‎/‎27‎/‎2018 at 4:22 PM, manymoretodays said:

 

Is your son able to participate here as well?

I know it's kind of a fine line with him being 16 now, and with some other difficulties, yet that might be helpful.  What do you think?

   

Although I would personally love to have my son participate on this forum, I don't see him joining in yet.  I am very open with him about his medications and why I would like to taper them.  I want him to understand what I am doing, be a part of making decisions for his body, and become educated and thoughtful about his decisions in the future.   

 

On ‎9‎/‎27‎/‎2018 at 7:50 PM, manymoretodays said:

Why was he ever put on risperdal??  Did they start the risperdal and Celexa/citalopram at the same time back in 2010?

 

Actually, I need to change my signature because I forgot to mention that my son was initially on citalopram from 2007 to 2009 to help with mood issues he was experiencing during treatment for cancer.  He came off citalopram in the spring of 2009 and everything seemed fine until 2010, when he fell apart emotionally.  My son has a complicated medical history and I think he deals with something called PANS (Pediatric Acute-Onset Neuropsychiatric Syndrome).  Perhaps you've heard of PANDAS?  PANS is similar to PANDAS and means that he has had psychiatric issues as a result of his immune system attacking parts of his brain -- kind of like rheumatic fever, but in the brain.  I have seen a correlation between illness and mood issues with my son for the past decade.  Recently I did take him to see a neurologist at a  PANS clinic who concurred that he does seem to have PANS (it is a clinical diagnosis).  Also, my son has been diagnosed with narcolepsy, which is another autoimmune disease caused by the immune system going haywire.  Pediatric narcolepsy seems to correlate with an increased risk of mental health issues. So, we've (it has profoundly affected my whole family) been on a roller coaster for over a decade.  And, to further complicate everything, my son has had brain radiation. 

 

My son was put on Risperdal because after a few months on the citalopram (in 2010) he was still having pretty serious moods about once a week (which, in retrospect, was most likely PANS...or maybe narcolepsy...or both?!).   

 

Also, my son is on Buspar because he developed intense anxiety after a horrible and fast taper off of Topamax.  He was given the Topamax by a neurologist for headaches and started it just as he was ending a too fast, unsuccessful taper off of Risperdal. A few months on Topamax caused MONTHS of serious issues and missed school. I think I need to also add this to my signature! 

 

7 hours ago, Altostrata said:

Stay with the 2 tablets plus liquid method for a few more steps until the next dose is about 19.7mg. Then you would switch to one 10mg tablet plus 9.7mg in liquid form.

 

(Personally, I would take two 10mg tablets or 20mg for this step, it's close enough to 19.7mg, you can take a month's break from measuring. In the next step, switch to one 10mg tablet plus 8mg in liquid.)

 

You had a question about rounding in the liquid measurement: I would round up to make the decrease smaller rather than larger. Be sure to make a note of your new measurement, because for the next step, you will want to calculate 10% on the actual last dosage.

 

As long as you stay within a 10% decrement, the taper will be slow enough.

 

Thanks!  I definitely can see how switching to all liquid would be ideal, but I think that given how much my son dislikes the taste of the liquid AND the fact that the liquid form is more expensive (my son's psychiatrist was concerned that insurance might decline the switch, but so far no problems), using a combination of pill and liquid is going to work best.

 

Also, your advice to just think of just staying within the 10% decrement when rounding is helpful.  I was making myself a bit crazy thinking I needed to be precise to the hundredth of a ml!  I will, of course, be more precise at lower dosages like I was when I was tapering him off of 1 mg of Risperdal.  

 

Thanks again!    

 

[Altostrata]

18 hours ago, popsicletoes said:

Also, my son is on Buspar because he developed intense anxiety after a horrible and fast taper off of Topamax.  He was given the Topamax by a neurologist for headaches and started it just as he was ending a too fast, unsuccessful taper off of Risperdal. A few months on Topamax caused MONTHS of serious issues and missed school. I think I need to also add this to my signature! 

 

To me, this indicates he doesn't need Buspar any more. However, deal with one drug at a time.

 

Please keep careful daily notes about what time of day your son takes each drug, their dosages, and significant symptoms throughout the day.

 

Is he taking anything for narcolepsy? How do you deal with that?

[popsicletoes]

I wanted to give an update on my son’s tapering progress (I am a mom helping her 16 year old son try to taper off his medication).

 

Currently my son is in the midst of tapering off of citalopram.  He started last October at a dose of 30 mg and is currently down to 18 mg.  He has been tapering at a rate of 10% reductions every four weeks.  So far things are going well. 

 

There are some challenges in helping an adolescent taper off of a medication.   Teenagers by nature can be moody and dramatic, so it can be hard to sort out what is normal behavior and what might be a withdrawal symptom.  Teenagers are not always very good at conveying what is happening with them and they don’t like a lot of questioning.  I would love to have my son do EVERYTHING possible to help him during the tapering process but my son has narcolepsy and his normal state is fatigued with limited stamina, so getting him to exercise lately has been a challenge.  Also, he has strong food aversions that started when he was undergoing treatment for cancer – getting him to eat a healthy diet is also a challenge (he eats an ok diet, I would just like more fruit and vegetables).  Still, he is doing well overall.

 

After A LOT of consideration and research (and consultation with his psychiatrist who is young, open-minded and supportive of the slow tapers), I am planning to begin tapering the other psychotropic medication he takes (buspirone) CONCURRENTLY with the citalopram taper.  My son is 16 and he is a sophomore in high school.  His plan is to go away to college when he graduates.  I cannot imagine my son taking on the process of tapering buspirone while living at college.  I can, however, imagine my son, who has executive functioning issues resulting from brain radiation, forgetting to take his medication and/or drinking while on medication.  Ideally I would only taper one medication at a time (if you read his history, I tapered him off of risperidone prior to beginning the citalopram taper), but I think it makes sense, for his particular situation, to try and safely taper him off of both medications slowly before he goes away to school.  If I don’t try to taper him now, he will go away to school still on buspirone and will most like stay on it for many extra years, potentially forgetting to take it periodically.  

 

As of this week, there are 133 weeks left until he potentially leaves home (I say potentially because it is, of course, too early to know what he will end up doing).  If I stick to reductions every 4 weeks, that leaves 33 reductions.

In researching this, I have seen support for the idea of tapering medications concurrently in SOME circumstances (I was reading the thoughtful posts from Rhiannon, for example).  I completely respect and agree with the standard advice of this site to taper one medication at a time.  I think in my son’s case, though, there is good reason to try and taper him off his medications while he is still living at home with me to help.  

 

My son takes 10 mg of buspirone in the morning and evening (total of 20 mg a day).  My plan is to dissolve the pills in water (thank you for the documentation provided on how to do this on this site!) and use a liquid solution to taper.  The process I plan to follow each time he is due to take buspirone is this:

 

-          Dissolve a 10 mg buspirone tablet in 10 mL of water (I will use a syringe to measure the 10 mL of water into a glass)

-          Extract the amount I am reducing the dose by with a syringe (so, for example, if he is going to take 9 mg of buspirone, I will extract and discard 1 mL of the solution after the pill has dissolved).

-          Have my son drink the dissolved buspirone solution and then add a little more liquid (probably lemonade) to the cup and have him drink that to pick up any residue that might be clinging to the cup  

   

Question: is it accurate enough for me to add 10 mL of water and then add the pill. The addition of the pill will then make a solution that is greater than 10 mL.  Am I overthinking this?  I could buy a small cylindrical beaker, put the pill in first and then add water up to the 10 mL line.   

 

I welcome any suggestions or wisdom or support anyone would like to offer!  I documented my planned process above both for suggestions and also to potentially help anyone starting out in similar circumstances.

We have had such horrible experiences with medication withdrawal in the past that I get nervous every time I make a change.

 

Also, I just noticed I did not respond to the post below. 

 

On 10/4/2018 at 4:14 PM, Altostrata said:

 

To me, this indicates he doesn't need Buspar any more. However, deal with one drug at a time.

 

Please keep careful daily notes about what time of day your son takes each drug, their dosages, and significant symptoms throughout the day.

 

Is he taking anything for narcolepsy? How do you deal with that?

 

The standard treatment for narcolepsy in adolescents is to give stimulants.  My son, his neurologist, and I are all in agreement that this in NOT a good approach for my son.  I have had providers encourage me to give him the stimulants ("they're not addictive", they say...ugh).  And I agree with you that he most likely does not need the Buspar.  It was immediately helpful at the time, but that was for anxiety resulting from a horrible withdrawal from Topamax.

 

[Altostrata]

pops, you seem to be doing everything very carefully. If your son suddenly seems to be having much worse symptoms, you'll know it's because of the simultaneous reduction of buspirone. You can stop reducing both drugs for a while and let everything settle down before going back to tapering citalopram.

 

On 2/7/2019 at 7:20 AM, popsicletoes said:

Question: is it accurate enough for me to add 10 mL of water and then add the pill. The addition of the pill will then make a solution that is greater than 10 mL.  Am I overthinking this?  I could buy a small cylindrical beaker, put the pill in first and then add water up to the 10 mL line.   

 

Add 10mL water (or whatever amount you decide for the dilutant)  to the tablet. Don't worry about the volume added by the tablet.

[popsicletoes]

18 hours ago, Altostrata said:

pops, you seem to be doing everything very carefully. If your son suddenly seems to be having much worse symptoms, you'll know it's because of the simultaneous reduction of buspirone. You can stop reducing both drugs for a while and let everything settle down before going back to tapering citalopram.

 

Thank you so much for taking the time to respond.  Any sort of medication changes make me nervous, so it is very nice to have the support.  I will definitely monitor my son very closely and stop reductions if I sense any sort of withdrawal symptoms.  NOTHING is worth seeing him go into severe withdrawal again.

 

On a related note, an article from the NYT discussing a nation-wide shortage of buspirone popped up in my news feed.  I am very sad to hear of people being forced to CT because they can't get their prescriptions filled.  Also a bit nervous because I had to drive to a pharmacy 30 minutes away this week to get my son's latest buspirone prescription filled (our regular pharmacy is out of buspirone) and was told by the pharmacist there that he is not currently able to order anymore.

 

Shortage of Anxiety Drug Leaves Patients Scrambling

[Altostrata]

I would consider tapering buspirone with the tablets you have on hand. I would start with the morning dose first.

[Carmie]

Hi popsicletoes, 

 

How are you doing?💚

[popsicletoes]

Hello all - I thought I would check in since it has been a long time since I posted.  As a reminder, I'm a mom of a now 17 year old teenager (with a complex medical history) and I've been helping him to taper off his psychotropic medications for about 2.5 years now.  And thank you, Carmie, for checking in last March.  Somehow I missed your post because I would have responded had I seen it!

 

My son is now at about 25% of his original dose of citalopram and about 40% of his original dose of buspirone. Tomorrow is reduction day!  I am duel tapering because it is the only way to do a 10% reduction and complete it by the time he possibly leaves for college in the Fall of 2021.  I know that medication compliance will be a big issue if he goes to college on medication (he would not purposefully be non compliant, he just has severe executive functioning issues).  I also don't see him doing a taper on his own while going to college.  And, I worry that he might experiment a bit with alcohol and I don't like the idea of alcohol + psychiatric medication. 

 

Overall the taper is going well.  I do notice that the week after I do a reduction, my son seems more irritable which manifests in him being a bit short-tempered and likely to call me inappropriate names.  I can deal with this.  

 

I have a couple of questions. 

 

First, my son has suffered from fatigue and stamina issues for years (lots of school missed, dropping out of activities that he enjoyed, etc.).  I have long suspected the medications, but was always told by professionals that it was not the medication.  My son also had cancer, so that could certainly contribute, but I still feel like it is the medications.  He had a sleep study a few years ago that pointed very strongly to narcolepsy but this summer he had a more definitive test (lumbar puncture) and he does not have narcolepsy.  Yay!  If the fatigue/stamina issues are medication related, is there any prevailing wisdom on when one might expect to see a decline in fatigue when tapering off?  I *think* I am seeing improvements as time goes by, but some weeks are better than others.  My son also is definitely affected by Seasonal Affect Disorder, so I anticipate more fatigue as the days get shorter.

 

My other question is about how to keep tapering while traveling.  My son has the opportunity to go out of the country next year summer on a school trip.  Neither my husband nor I will be going on that trip.  My son is also looking into a few summer pre-college courses he could take that would require him to be away from home for a number of weeks.  The way I am tapering is to give him liquid citalopram and, for the buspirone, I dissolve a tablet in water and extract the appropriate amount.  Any advice on how to keep him on track with tapering.  I do not want to send liquid medication with him.  Would I be able to go to a compounding pharmacy to get tablets made up?  I am concerned about cost and accuracy.  I know I have some time to figure this out, but, it is a big concern of mine! 

 

Thank you!

[Gridley]

20 minutes ago, popsicletoes said:

First, my son has suffered from fatigue and stamina issues for years (lots of school missed, dropping out of activities that he enjoyed, etc.).  I have long suspected the medications, but was always told by professionals that it was not the medication. 

 

Fatigue is not listed as a common side effect of Citalopram, but it is a common side effect of buspirone.   Generally side effects lessen as dosage decreases, so that's encouraging.  Fatigue is a common withdrawal symptom, however.  Google SurvivingAntidepressants.org fatigue for more information.  

 

25 minutes ago, popsicletoes said:

 I do not want to send liquid medication with him.  Would I be able to go to a compounding pharmacy to get tablets made up?  

 

The concern here is that a change in the form of the drug (e.g., liquid to compounded tablet) can cause an uptick in symptoms or even not be tolerated.  To minimize disruption, we recommend a gradual crossover from the old form to the new lasting anywhere from 9 to 21 days, followed by a hold period.  Then, once your son returned, you'd have to do the crossover again to get back on the liquid.  Obviously, that's a lot of changes for your son's system to have to go through.  

 

[Ariel]

Hello @popsicletoes

How are you doing? How's your son?

Wishing you well,

A.